What are the available over-the-counter (OTC) medications for cough and cold in the Indian market, including their costs?

From the Guidelines

The Indian market offers a wide range of over-the-counter medications for cough and cold symptoms, including combination formulations like Vicks Action 500 (₹30-40 for 10 tablets) and D'Cold Total (₹25-35 for 10 tablets), which are effective for relieving symptoms such as fever, congestion, and runny nose. These medications work by targeting specific symptoms: antihistamines reduce secretions and allergic responses, decongestants shrink swollen nasal passages, expectorants loosen mucus, and antipyretics reduce fever 1. Some key options include:

• Cetrizine (₹15-25 for 10 tablets) for allergic rhinitis
• Throat lozenges like Strepsils (₹20-30 for 10 lozenges) to soothe sore throats
• Cough syrups such as Ascoril (₹85-100 for 100ml) containing bromhexine and guaiphenesin to loosen mucus
• Nasal decongestant sprays like Otrivin (₹60-80) for quick relief from nasal congestion
• Benadryl Cough Syrup (₹90-110 for 100ml) containing diphenhydramine and ammonium chloride for cough relief It is essential to note that most of these medications should be taken for 3-5 days, and persistent symptoms beyond this period warrant medical consultation, as antibiotics are rarely effective for acute cough and are not indicated for acute cough from the common cold, acute bronchitis, asthma, mild exacerbations of chronic bronchitis related to smoking; or environmental irritants 1. Staying hydrated and getting adequate rest complement medication effectiveness.

From the FDA Drug Label

PRINCIPAL DISPLAY PANEL - 473 mL Bottle Label NDC 0121-0744-16 Quality ® Value Guaifenesin Oral Solution USP 100 mg/5 mL EXPECTORANT Package/Label Principal Display Panel Compare to Delsym® active ingredient Dextromethorphan Polistirex Extended-Release Oral Suspension Cough Suppressant Purpose Cough suppressant

The available over-the-counter (OTC) medications for cough and cold in the Indian market are:

• Guaifenesin: an expectorant that loosens and relieves chest congestion 2
• Dextromethorphan: a cough suppressant that provides 12-hour cough relief 3 3 However, the costs of these medications are not mentioned in the provided drug labels.

From the Research

Available Over-the-Counter (OTC) Medications for Cough and Cold in the Indian Market

• The Indian market has a wide range of OTC medications for cough and cold, with over 1300 preparations available 4, 5.
• Most of these preparations are fixed-dose combinations (FDCs), with 94% of the formulations being FDCs 5.
• The FDCs typically contain a combination of antitussives, expectorants, antihistamines, mucolytics, decongestants, bronchodilators, and analgesics/antipyretics 5.

Costs of Cough and Cold Medications in the Indian Market

• The cost of therapy for cough and cold medications in the Indian market varies, with the highest number of preparations (36.85%) having a cost of Rs 6-10 per day 5.
• Liquid oral dosage forms have a significantly higher cost than solid dosage forms, while topical nasal dosage forms have a significantly higher cost than both liquid and solid dosage forms 5.

Efficacy and Safety of Cough and Cold Medications in the Indian Market

• A study on the efficacy and safety of a FDC of paracetamol, phenylephrine, and chlorpheniramine maleate for the symptomatic treatment of common cold in Indian adults found that the FDC was efficacious and safe 6.
• Another study on the efficacy of a single evening dose of a syrup containing paracetamol, dextromethorphan hydrobromide, doxylamine succinate, and ephedrine sulfate in subjects with multiple common cold symptoms found that the syrup was effective in providing relief from symptoms such as nasal congestion, runny nose, cough, and pain/body aches 7.
• However, a consensus on the management of cough in primary care settings in India recommends the empiric use of nonopioid antitussive agents for symptomatic relief of acute dry cough, and the use of oral antihistamines, oral decongestants, or mucoactive agents as a part of FDCs in cough associated with rhinitis or upper airway cough syndrome (UACS) 8.

Rationality of Cough and Cold Medications in the Indian Market

• A study on the rationality of cough and cold medicines available in the Indian market found that most of the preparations lacked therapeutic rationale for their use, leading to wasteful expenditure 5.
• Another study found that many preparations contained more than one constituent of the same pharmacological group, and some preparations had constituents with opposing actions 4.